Burial PermitCounty. .-..lJp X).,, STATE OF MINNESOTA
Township ... -- - REGISTRAR'S
N
o.. . ........
City— .................................... Permit for Burial or Removal
Date of Deat .......` ? !' .... .C?... .........19.z
Full Name _ __.�.1Utt/ .. .........Age......... .
Disease causing death ........ a_LL(!:...........4 zed' ..................................
Medical t l hoed date of
A j .2- ..eS.�1�►►t►f�.......lurWl or rcWmal f ...
Place of Burial ... .............................................. ........
Place of remov.................................................via..............
..................
�.Address.
............
A certificate of death having been or in dance with the laws
of Minnesota, I hereby authorize the..l1___._..._of the body
(Burial or Removal-)
of said deceased person as stated above. In the can of death from a dangerous
communicable disease, the burial or removal must be cgnducted according to the rules
of the State and local board of health./// , /1
Dated...( - .4-.j .......
Oficial Title
•Wri to 'Burial" or "Removal" as the case may be. Burial permits must be deliv-
ered by the Undertaker to the Sexton. Removal permits must be given to the Agent
of Transportation Company, and attached by him to box Containing body. Subregls-
trars will write "Sub" before the works 'Registrar of Deaths" and "Lleensed Em-
balmer No. ^ below, always giving No. of License. Fine or Imprisonment for
receiving a body for burial without a permit.
The sexton or person in charge of cemetery should give date of reoelpt and sign
his name below, then forward this permit to the local re5istrar of the town, village
or city in whichthe cemetery Is located.
Received- ......_._..... 191-- -- - - - - --.------.Sexton
Name of Cemetery_____—_—__. Addrew.-
NOTICE TO UNDERTAKERS.
This blank constitutes a Registrar's 'Burial Permit" or "Removal Permit," accord-
ing to the manner in which it is filled out by the Registrar.
As a Registrar's Burial Permit it must be obtained by the undertaker before any
disposition is made of the body. It is the duty of the undertaker to have a certificate
of death properly filled out with the personal and statistical facts required by law,
to present it to the attending physician for his certificate of cause of death, and then
to file the complete certificate of death with the Registrar of the district where the
death occurred Sextons should not permit the interment of a body unaccompanied by
a regular Burial or Removal Permit.
As a Registrar's Removal Permit this blank must be obtained from the Registrar
as above, presented by the undertaker to the Agent of the Transportatioti Company,
and be attached by the latter to the box containing the body. The Removal Permit is
not a Transit permit. The latter, supplied to undertakers by the State board of health,
provides for a statement of--t?W proper preparation of the body Tor transportation,
signed by the Health Officer, and contains Removal Permit. No transit permit can be
issued by any health officer or accepted by the agent of any transportation company
in Minnesota unless a Registrar's Removal Permit forms part of it or has previously
been issued by the registrar of deaths.
ISSUE OF PERMITS BY SUBREGISTRARS.
A licensed embalmer, holding an unrevoked certificate of authority from the State
Board of Health to act as subregistrar of deaths, can use this blank for the issue of a
permit for burial or removal to himself, under the same restrictions as those govern-
tng its issue by a rg&jraz, except in cities having ]Deal ordinances governing burial
and removal pertaW The certificate of death, fully made out in ink, and signed by
informant and physician, must be in his possession before issue of permit, and the
certificate must be personally delivered to the registrar of the township or village
where death occurred within ten days.